Cases of COVID-19 in Africa represent a tiny fraction of those in other countries, but countries in the region are still taking strong action to slow the spread of the virus: closing borders, imposing curfews, closing schools, and more. These actions – along with those that other countries take to slow the spread, such as factory closings in China – have economic consequences in addition to health consequences. Estimates for African growth in 2020 have fallen dramatically, with impacts from tourism to manufacturing. Africa is the continent with the highest number of poor people in the world, which means the consequences of an economic downturn come with greater risks. Are the actions that high-income countries are taking to stop the pandemic the same ones that Africa’s low- and middle-income countries should take?
Slowing the tide of the pandemic and limiting the impact on the economy are closely connected. The spread of the disease keeps workers from the job because they fall ill (or, tragically, die) or have to care for sick family members. Yet the economic impacts come with their own health effects, with more deaths from hunger and other health conditions. Allowing businesses to continue as usual can facilitate the spread of the virus, but many of Africa’s workers are in the informal economy, where staying home means not getting paid. Expanding the safety net may be good for slowing the spread (as it allows workers to stay home and still afford food), but thus far, African nations have been the slowest to expand social protection to cushion the impact of virus containment measures.
Africa’s young population
One key way that Africa’s nations differ from those of high-income countries are that they have much younger populations. Across Africa, more than half the population is under the age of 20, compared to just 22 percent in high-income countries. At the same time, recently published estimates suggest that a teenager is more than 500 times less likely to die conditional on getting infected than a person in their seventies. In Africa, around 2 percent of the population is in their seventies or older. This has dramatic potential implications for the impact of the virus on population mortality.
Here are some assumptions underlying this analysis: (1) 90 percent of the population would be infected. This is a recent estimate in the face of no mitigation efforts. Obviously, countries are taking actions to mitigate the spread, so this is a pessimistic scenario. (2) The percentage of infected persons in each age group who will die come from cases in China. These estimates range from a mortality rate of 0.00 percent for children age 0-9 to a rate of 13.4 percent for adults age 80 and above. We use the latest United Nations population estimates for 2020. We are not epidemiologists, and the numbers we provide are not intended to be predictions of the actual mortality rate across countries, but rather demonstrations of how much the mortality rate could be affected by differing age distributions.
Under those assumptions, 1.8 percent of the population of high-income countries would die from the pandemic, whereas “only” 0.4 percent of the population of Africa would die. That means a mortality rate in Africa that is less than a quarter the size of that in high-income countries. The effects are even more striking for the countries with the youngest populations. For example, in Uganda, almost one third of the population is under the age of 10. There, the projected mortality rate would be just 14 percent of that in high-income countries. In Zambia, the mortality rate would be just 15 percent of that in high-income countries. The interactive figure shows how the rate would vary across the continent.
Figure: The mortality rate in African countries relative to high-income countries, according to the age structure
While the age structure of the population could reduce the fatality rate dramatically, there are other factors that could increase it. People with existing health issues (called comorbidities) are at higher risk of fatality from COVID-19: Africa’s populations face many of these, including the highest concentration of people living with HIV/AIDS of any region in the world by more than a factor of six and the highest burden of disease overall. Furthermore, African hospitals may be more poorly staffed and equipped than those in China – the place the mortality data came from – which means that mortality rates may be higher. Whether these factors are sufficient to outweigh the impact of Africa’s youthful population is yet to be determined.
What does this imply?
From epidemiologists, we need models of the spread of COVID-19 and the impact of different containment measures with parameters specific to Africa’s low- and middle-income countries with their different age distributions, health care resources, and household sizes. A recently-released paper from Imperial College goes partway there, including Africa in a worldwide model. The logic of “flattening the curve,” which in high-income countries relates to the capacity of intensive care beds and ventilators, needs to be theorized appropriately for a low-income context, where those medical resources are already much scarcer.
Every death is tragic, so it may seem callous to highlight this point. But especially in Africa’s low-income countries, the increase in extreme poverty resulting from an economic slowdown will be higher, which translates into its own death toll. Moreover, in low-income countries the government’s room for fiscal stimulus and the effectiveness of monetary stimulus are much lower than high-income countries. As a result, the right balance of decisions to contain the virus versus to protect the economy may be different from that in high-income countries.
Finally, this balance has implications for the role of high-income countries in fighting COVID-19 in African settings. High-income countries reap some of the benefits from African countries containing the virus, since COVID-19 spreads beyond borders and high-income countries have more to lose in terms of mortality. As a result, high-income countries should have an even stronger incentive to use their resources — stretched though they might be right now — to help African countries contain the virus and protect their vulnerable peoples and economies.
This article benefitted from research assistance by Amina Mendez Acosta. This article is adapted from our previous article, “What a Population’s Age Structure Means for COVID-19’s Impact in Low-Income Countries.” The estimates have been updated with more recent data on fatality rates.